EMEAB4 Amiens, july 2000, 9-13 Inscription form

Print and send this form with payment to :  Michel Sokolowski - EMEAB4  Fac de Philo, Sci Hum & Soc  UPJV, Chemin du Thil, 80025 Amiens, France  Fax: 00 33 (0)3 22 82 74 08  msokolowski@nordnet.fr

Name:	First name:
Postal address:
	Country:
Tel:	Fax:
Electronic address:	Arriving time:

University accommodation booking (CROUS).
Price for a night: 140 FF (21,34 Euros, single room, bed & breakfast).
Refund : 100 % before march 31, 75 % before may 31, 0 % after may 31.

			nights
july 8th	july 9th	july 10th	july 11th	july 12th	july 13th	july 14th

Number of nights :
Dues in (FF or in Euros) :

Restaurant:
University restaurant available (ticket only for lunch meals: 48 FF or 7,32 Euros) or restaurants and pubs near the university (quai Saint-Leu)

Number of tickets (university restaurant) :
Dues (in FF or in Euros) :

Meeting registration:

Type :	Student	Delegate
Payment before march, 31 :	300 FF (45,73 Euros)	600 FF (91,46 Euros)
Payment after march, 31 :	400 FF (60,98 Euros)	800 FF (121,95 Euros)
Booking fee :	80 FF (12,20 Euros)	80 FF (12,20 Euros)
Dues (in FF or in Euros) :

Summary (choose Francs or Euros) :

	in FF	in Euros
University accomodation dues :
University restaurant dues :
Meeting registration dues :
Total dues :

Payment conditions

All payments should be made in French Francs or in Euros. You can choose the type of payment: by cash (during the meeting), by check (payable to "Verne - Ader"), by direct bank transfer (on the account: Crédit Lyonnais Amiens 30002/05024/0000079046K20. Please, be sure your name and EMEAB4 appear on the bank transfer order) and by administration order (to "Verne - Ader"). Students should send a proof of their position to obtain reduced registration prices.

Date and signature

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